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The Maryland P 3 Program: A Collaborative Solution to Medication Therapy Management . Magaly Rodriguez de Bittner, PharmD, BCPS, FAPhA, CDE Professor and P 3 Director. Outline. Pharmacy Education Program Overview Preliminary Program Results Impact on Public Health Needs. - PowerPoint PPT Presentation
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The Maryland P3 Program: A Collaborative Solution to
Medication Therapy Management
Magaly Rodriguez de Bittner, PharmD, BCPS, FAPhA, CDE
Professor and P3 Director
© 2006 University of Maryland School of Pharmacy. All rights reserved.
OutlinePharmacy Education
Program Overview
Preliminary Program Results
Impact on Public Health Needs
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Patients Pharmacists Partnerships (P3) Program
An effective solution to patient-centered health education, medication adherence, and chronic disease management
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Informed,Activated Patients
ProductiveInteractions
Prepared,ProactivePractice Team
DeliverySystemDesign
Decision Support
ClinicalInformation
Systems
Self-Management
Support
Health System:
Resources and Policies
Community: Health Care Organization
Chronic Care Model
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Maryland P3 (Patients, Pharmacists, Partnerships)
Maximizes the role of the pharmacist (medication expertise)
Pharmacists serving as “coaches” to stress self-management education
Delivery system design (aligned incentives, convenient location)Decision support working collaborative with the
patient’s physician and other health care providersData Collection System-MedPath
© 2006 University of Maryland School of Pharmacy. All rights reserved.
• This pharmacist-delivered diabetes management initiative arose out of an effort to improve patient health and reduce employer health costs
• Began in 2006 with one employer in Western Maryland• Now involves 6 employers and ~500 employees• Support from DHMH and the Maryland Legislature
• Patients engaged in self-management• Employers provide benefits and waive co-pays• Pharmacists deliver care and coordinate care with primary care providers and specialists
The Partnership
The History
© 2006 University of Maryland School of Pharmacy. All rights reserved.
medication experts on the health care team
• Meet face-to-face with patient 5-7 times depending on patient needs
• Counsel patients on medication adhering and self-management• Educate patients on medication, and possible drug interactions, as
well as adverse effects • Coach patient in self-management skill development• Help with personal goal setting (therapeutic indicators)• Coordinate referrals for necessary
laboratory tests and specialist visits (annual eye and foot exams, and dental check ups)• Immunizations for pneumococcal
and influenza
American Diabetes Association Clinical Care Guidelines (2011)
The Pharmacists
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Patients
Pharmacists Partnerships• Maryland
Pharmacists Association
• P3 Pharmacy Network
UMB School of Pharmacy
Network CoordinationTraining
PSM System/Reporting
Self-management of chronic disease
• Department of Health and Mental Hygiene
• Maryland General Assembly
• Employers/Payers
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Results From Early Program Implementations
Total Healthcare Costs (Rx and Medical)Mission Hospitals & City of Asheville
Combined
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
Prior to Program 1997 1998 1999 2000 2001
Prior to program & each year of the program for 1st 5 yearsnote 10 participants were new employees that did not have baseline economic data
Avg
. / D
iabe
tes
patie
nt /
Year
Other RxDiabetes RxMedical Claims
$7,042
$4,669$4,288
$4,677
$4,129$4,371
Avg. U.S. 7,008 U.S. 7,239 U.S. $7,485 U.S. $7,762U.S. $8,088
U.S. $8,468
ALL plan employees
National avg. ALL employees
n = 164 n = 47 n = 72 n = 131 n= 147 n = 174
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Baseline, Year 1, 2 and 3 compared toProjected Costs*
Average Annual Costs to Employer for Participants
$0$2,000$4,000$6,000$8,000
$10,000$12,000$14,000
Pharmacist $0 $414 $268 $240 Medication $1,667 $3,045 $3,748 $3,093 Medical $7,368 $5,454 $4,786 $4,157
Baseline 2002 Year 1 Actual Year 2 Actual Year 3 Actual
Total costs $9,035 $8,913 $8,802$7,490
Yr 3 savingsPer Patientfrom projected Costs
$6,250from Baseline Costs
$1,545
Yr 1 Projected
$10,390
Year 3 Projected
$13,740
*for 63 patients with baseline,1st, 2nd and 3rd year results
Baseline
$9,035
Year 2 Projected
$11,948
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Patient Self-Management ProgramSM
for Diabetes: First Year Cost SavingsJ Am Pharm Assoc. 2005; 45: 130-137
Average Cost Per Patient
$0
$2,000
$4,000
$6,000
$8,000
$10,000
MTMS $0 $351Medication $3,128 $3,373Medical $6,254 $4,740
Projected Year 1 Actual Year 1
AverageCost SavingsPer Patient$918
Align the Incentives, Empower the Patient, Control the CostsSM
Combined data from Mohawk, VF, Manitowoc, OSU, Kroger (n=165)
© 2006 University of Maryland School of Pharmacy. All rights reserved.
The Diabetes Ten City ChallengeInterim Results: n=914, 10.2 months
Through 30-Sep-07, 29 employers, 10 cities: – Charleston, South Carolina– Chicago, Illinois– Colorado Springs, Colorado
–Cumberland, Maryland– Honolulu, Hawaii– Milwaukee, Wisconsin– Northwest Georgia– Pittsburgh, Pennsylvania– Los Angeles, California– Tampa Bay, Florida J Am Pharm Assoc 2008;48:181-190.
© 2006 University of Maryland School of Pharmacy. All rights reserved.
CAN THE P3 PROGRAM MODEL IMPROVE CLINICAL
OUTCOMES AND DECREASE HEALTH CARE COSTS FOR PEOPLE WITH DIABETES?
© 2006 University of Maryland School of Pharmacy. All rights reserved.
© 2006 University of Maryland School of Pharmacy. All rights reserved.
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Key < 130/80 < 140/90
Figure 4. Blood Pressure at Therapeutic Levels (mmHg)
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Results 2009 (N= 159 patients )
Alc 8.1-9 A1c 7.0 to 8.0 Alc 6.6 to 6.9 Alc < or = 6.50
5
10
15
20
25
30
35
40
P3 Participants HbA1c Status Pre and Post In-tervention
PrePost
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Results 2009 (N=159)
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Results 2009 (N=159)
A1c Control < 8.0% BP Control < 130/80 mm Hg
BP Control <140/90 mm Hg LDL < 100 mg/dL0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Comparison of National HEDIS Commercial Rates (2009) vs. P3 Participants
P3 ParticipantsNational HEDIS Commercial
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Cost Savings for the Maryland P3 Program
On average our employers are saving approximately $900 per employee per year ($495-$3,281).
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Track Record of Success:Clinical outcomes:
improvement in clinical indicators such as A1C and LDL measures
Economic outcomes: reduced overall costs of care
Satisfaction results: high employee satisfaction with the program and
pharmacist care
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Implications:Public Health Issues1. Underserved Populations2. Health care Reform- Patient Centered
Medical Home and Transitioned of Care3. Team-based Care4. Access to Health Care and Prevention
Services
© 2006 University of Maryland School of Pharmacy. All rights reserved.
2010 Recipient of the APhA Foundation Pinnacle Award
© 2006 University of Maryland School of Pharmacy. All rights reserved.
Conclusions/Lessons Learned 1. Pharmacists are an innovative and effective solution to
control chronic disease by improving clinical, humanistic and economic outcomes
2. Pharmacists accessibility and geographic location-in every patient’s neighborhood- has a significant strategic potential
3. Collaboration between the Departments of Health/Office of Chronic Diseases, academic institutions, professional organizations and private employers have proven to be effective maximizing resources and increasing efficiency of chronic disease initiatives